scholarly journals Nutrition in Cancer Therapy in the Elderly—An Epigenetic Connection?

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3366
Author(s):  
Janusz Blasiak ◽  
Jan Chojnacki ◽  
Elzbieta Pawlowska ◽  
Joanna Szczepanska ◽  
Cezary Chojnacki
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Cancer Therapy ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
The Elderly ◽  
Assessment Tools ◽  
Continuous Increase ◽  
Epigenetic Profile

The continuous increase in life expectancy results in a steady increase of cancer risk, which consequently increases the population of older adults with cancer. Older adults have their age-related nutritional needs and often suffer from comorbidities that may affect cancer therapy. They frequently are malnourished and present advanced-stage cancer. Therefore, this group of patients requires a special multidisciplinary approach to optimize their therapy and increase quality of life impaired by aging, cancer, and the side effects of therapy. Evaluation strategies, taking advantage of comprehensive geriatric assessment tools, including the comprehensive geriatric assessment (CGA), can help individualize treatment. As epigenetics, an emerging element of the regulation of gene expression, is involved in both aging and cancer and the epigenetic profile can be modulated by the diet, it seems to be a candidate to assist with planning a nutritional intervention in elderly populations with cancer. In this review, we present problems associated with the diet and nutrition in the elderly undergoing active cancer therapy and provide some information on epigenetic aspects of aging and cancer transformation. Nutritional interventions modulating the epigenetic profile, including caloric restriction and basal diet with modifications (elimination diet, supplementary diet) are discussed as the ways to improve the efficacy of cancer therapy and maintain the quality of life of older adults with cancer.

A prospective study of the impact of chemotherapy-related toxicities on the quality of life in elderly patients with cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23013-e23013
Author(s):  
Sanketh Kotne ◽  
Bharadwaj Ponnada ◽  
Arun Philip ◽  
Pavithran Keechilat
Keyword(s):  
Quality Of Life ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Geriatric Assessment ◽  
Mental Status ◽  
Comprehensive Geriatric Assessment ◽  
The Elderly ◽  
Assessment Tools ◽  
Elderly Cancer Patients

e23013 Background: Treatment of cancer in elderly is challenging. Majority of the elderly cancer patients are offered chemotherapy based on their performance scale and geriatric assessment tools are not routinely employed in clinical practice as they are time consuming and cumbersome. Aim: The primary objective was to estimate the incidence of chemotherapy related adverse events in newly diagnosed elderly cancer patients above 65 years of age treated at a tertiary cancer institute in southern India. The secondary objective was to predict and assess the factors associated with chemotherapy related toxicities in the elderly patients using the Cancer and Aging Research Group's (CARG) scoring tool and to study the quality of life and to assess the nutritional status and the mental status in elderly cancer patients above 65 years of age. Methods: A prospective cross-sectional study was done among 179 patients with age ≥ 65 years, a solid organ cancer (any type or stage) from February 2017 to August 2018. Prechemotherapy comprehensive geriatric assessment (CGA) with Older People’s Quality of Life Questionnaire (OPQOL-35), Mini Nutritional assessment (MNA) and Folstein’s Mini Mental status examination (MMSE) was done at baseline, 2 months and 6 months. CARG tool was used to predict the risk of chemotherapy toxicity with the standard and modified dose. Results: The mean age was 68.53 years. Majority of the patients had breast cancer 29.60%. The proportion of lung cancer, prostate cancer, stomach cancer, colorectal and ovarian cancers were 21.80%,10.60%, 9.50%, 14.5% and 7.30% respectively. Other cancers were seen in 5 patients (2.79%). 40 (22.30%) patients had received anthracycline based chemotherapy. 143 (79.90%) had received standard dosing chemotherapy.118 (65.90%) & 125 (69.80%) out of 179 patients had developed hematological toxicities and non- hematological toxicities respectively. According to the ROC curve for the CARG tool risk of toxicity with standard & modified dosing and hematological & non- hematological toxicities, the accuracy of the test is 60.89% indicating its poor predictive validity. There is a decline in the CGA at 2 months follow-up, but there was an improvement after assessment at 6 months. Conclusions: Comprehensive geriatric assessment at base line is required to adequately analyse patient’s risk of chemotherapy related toxicities. In our study, the patients have tolerated the chemotherapy well in spite of receiving standard dosing.

Comprehensive geriatric assessment and management for Canadian elders with Cancer: The 5C study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12011-12011
Author(s):  
Martine Puts ◽  
Naser Alqurini ◽  
Fay Strohschein ◽  
Johanne Monette ◽  
Doreen Wan-Chow-Wah ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Data Collection ◽  
Cancer Treatment ◽  
Functional Status ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Primary Outcome ◽  
Group Performance

12011 Background: Comprehensive Geriatric Assessment (CGA) is recommended by ASCO for older adults with cancer undergoing chemotherapy to identify issues that can interfere with treatment delivery and optimize functional status and quality of life. However, few randomized controlled trials have been completed so far. Our objective is to evaluate the effectiveness of CGA on improving quality of life for older adults receiving cancer treatment. Methods: Eligible patients were aged 70+, diagnosed with a solid tumour, lymphoma or myeloma, referred for first/second line chemotherapy, speaking English/French, and with an Eastern Collaborative Oncology Group Performance Status 0–2. The CGA was done by a nurse and geriatrician followed by monthly phone calls by the study nurse for 6 months. Patients were randomly assigned (1:1) to receive either the intervention (CGA plus follow-up by geriatric trained team in addition to usual oncology care) or usual care alone. All participants received a monthly healthy aging booklet for attention control. Randomization was stratified by center and treatment intent (curative/adjuvant versus palliative). Our primary outcome was health-related quality of life (HRQOL) assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 global health scale (items 29 and 30). Secondary outcomes include functional status (Instrumental Activities of Daily Living). Outcome data collection was completed monthly for the first 6 months, then at 9 and 12 months. For the primary outcome we used a pattern mixture model using an intent-to-treat approach (at 0, 3, and 6 months). The last data collection took place March 8 2021. Results: From May 2017 to March 2020, 351 participants from 8 hospitals across Canada were enrolled. All patients were seen on or after day 1 of treatment for the intervention per patient request. Patient characteristics at baseline were similar in both arms. The average age was 75.7 (SD = 4.8), 60.4% was male and 54.3% had treatment with palliative intent. Change in HRQOL scores did not differ by arm (p =.80). Neither group exceeded the MCID of 10 points. There was also no difference in IADL between the groups (p = 0.82). Conclusion: CGA was not effective in improving quality of life for older adults receiving cancer treatment in this study. CGA may need to be performed prior to treatment initiation to achieve benefits. Clinical trial information: NCT03154671.

scholarly journals Multiple Myeloma in the Older Adult: Better Prospects, More Challenges

2014 ◽  
Vol 32 (24) ◽  
pp. 2531-2540 ◽  
Author(s):  
Tanya M. Wildes ◽  
Ashley Rosko ◽  
Sascha A. Tuchman
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Multiple Myeloma ◽  
Geriatric Assessment ◽  
Potential Role ◽  
Assessment Tools ◽  
High Dose ◽  
Younger Adults ◽  
Disease Response

Purpose Multiple myeloma (MM) is disproportionately diagnosed in older adults; with the aging of the population, the number of older adults diagnosed with MM will increase by nearly 80% in the next two decades. Duration of survival has improved dramatically over the last 20 years, but the improvements in older adults have not been as great as those in younger adults with MM. Methods In this article, we address treatment approaches in older adults who are eligible for and those ineligible for high-dose therapy with autologous stem-cell transplantation as well as supportive care considerations and the potential role for geriatric assessment in facilitating decision making for older adults with MM. Results The evidence from recent studies demonstrates that combinations of novel and conventional antimyeloma agents result in improved response rates and, in some cases, improved progression-free and overall survival. However, some older adults are particularly vulnerable to toxicities of therapy and discontinuation of therapy and, consequently, they have poorer survival. In addition, older adults may prioritize other outcomes of therapy, such as quality of life, over more conventional end points such as disease response and duration of survival. Geriatric assessment can facilitate risk-stratification of older adults at greater risk for adverse events from therapy and aid in personalizing therapy for vulnerable or frail older adults. Conclusion Survival in older adults with MM is improving with novel therapeutics, but efficacy must be balanced with risk of toxicity of therapy and maintenance of quality of life. Novel instruments such as geriatric assessment tools may facilitate these aims.

scholarly journals Can Comprehensive Geriatric Assessment Predict Tolerance of Radiotherapy for Localized Prostate Cancer in Men Aged 75 Years or Older?

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 635
Author(s):  
Aurore Goineau ◽  
Loïc Campion ◽  
Jean-Marie Commer ◽  
Brigitte Vié ◽  
Agnès Ghesquière ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
The Elderly ◽  
Localized Prostate Cancer ◽  
Curative Intent ◽  
Moderate Reduction ◽  
Curative Radiotherapy

Curative radiotherapy for prostate cancer is common in the elderly. However, concerns about potential toxicity have inhibited access to radiotherapy for this population, for whom preserving quality of life (QoL) is crucial. The primary endpoint was to identify predictors of impaired QoL in men aged 75 years or older treated with curative intent radiotherapy with or without androgen deprivation therapy (ADT) for localized prostate cancer. We prospectively performed comprehensive geriatric assessment (CGA) and administered QoL questionnaires to 208 elderly (>75 years) patients prior to, plus two and six months after, radiotherapy (NCT 02876237). The median age of the patients was 77 years (range 75–89). At the start of the study, comorbidities were highlighted in 65% of patients: 23% were depressed, 23% had cognitive impairment, and 16% had reduced independence. At six months, 9% of patients had a consistently decreased QoL (>20 points), and a further 16% had a more moderate reduction (10 to 20 points) in QoL. None of the parameters studied (tumor characteristic, treatment, or oncogeriatric parameters) were predictive of a reduced QoL following radiotherapy. Though co-existing geriatric impairment was common, QoL was maintained for 75% of patients six months after radiotherapy. CGA was poorly predictive of tolerance of prostatic radiotherapy. Geriatric assessments dedicated to quality of life following radiotherapy need to be developed.

scholarly journals Evaluation of the efficacy of hearing aids in older adults: a multiparametric longitudinal study protocol

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Domenico Cuda ◽  
Sara Ghiselli ◽  
Alessandra Murri
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Speech Perception ◽  
Hearing Aids ◽  
Assessment Tools ◽  
Elderly Subjects ◽  
Single Subject ◽  
Measurement Tools ◽  
First Time

Abstract Background Prevalence of hearing loss increases with age. Its estimated prevalence is 40–50 % in people over 75 years of age. Recent studies agree that declinein hearing threshold contribute to deterioration in sociality, sensitivity, cognition, and quality of life for elderly subjects. The aim of the study presented in this paper is to verify whether or not rehabilitation using first time applied Hearing Aids (HA) in a cohort of old people with hearing impairment improves both speech perception in a noisy environment over time and the overall health-related quality of life. Methods The monocentric, prospective, repeated measurements, single-subject, clinical observational study is to recruit 100 older adults, first-time HA recipients (≥ 65 years).The evaluation protocol is designed to analyze changes in specific measurement tools a year after the first HA usage in comparison with the evaluation before HA fitting. Evaluations will consist of multiparametric details collected through self-report questionnaires completed by the recipients and a series of commonly used audiometric measures and geriatric assessment tools. The primary indicator of changes in speech perception in noise to be used is the Italian version of Oldenburg Satz (OLSA) test whereas the indicator of changes in overall quality of life will be the Assessment of Quality of Life (AQoL) and Hearing Handicap Inventory for the Elderly (HHIE) questionnaires. The Montreal Cognitive Assessment (MoCA) will help in screening the cognitive state of the subjects. Discussion The protocol is designed to make use of measurement tools that have already been applied to the hearing-impaired population in order to compare the effects of HA rehabilitation in the older adults immediately before first HA usage (Pre) and after 1 year of experience (Post). This broad approach will lead to a greater understanding of how useful hearing influences the quality of life in older individuals, and therefore improves potentials for healthy aging. The data is to be analyzed by using an intrasubject endpoint comparison. Outcomes will be described and analyzed in detail. Trial registration This research was retrospectively registered underno. NCT04333043at ClinicalTrials.gov (http://www.clinicaltrials.gov/) on the 26 March 2020. This research has been registered with the Ethics Committee of the Area Vasta Emilia Nord under number 104, date of approval 17/07/2017.

scholarly journals Comprehensive Geriatric Assessment in Consecutive Newly-Diagnosed Elderly Multiple Myeloma Patients in China: A Multicentered, Prospective, Non-Interventional Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5493-5493
Author(s):  
Yuan Yao ◽  
Dehui Zou ◽  
Aijun Liao ◽  
Xiaoxia Chu ◽  
Wei Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
Clinical Trials ◽  
Cognitive Impairment ◽  
Geriatric Assessment ◽  
Real World ◽  
Comprehensive Geriatric Assessment ◽  
Newly Diagnosed ◽  
Frail Patients

Background: Multiple Myeloma (MM) is a disease of the elderly, whose prognoses are highly heterogeneous. Hence International Myeloma Working Group (IMWG) proposed geriatric assessment (GA) in 2015, including daily activity and comorbidity status, to better discriminate between fit and frail patients (Palumbo et al, 2015). However, IMWG recruited patients from clinical trials instead of real world practices. Therefore we studied GA in elderly MM patients consecutively in China, along with other perspectives which are known to be problematic in elderly population that were previously left unnoticed, such as nutrition status, risk of cognitive impairment, risk of depression, and quality of life. Aim: Our study centers on the feasibility to perform a more comprehensive geriatric assessment (cGA) in elderly MM patients, current cGA status in elderly MM patients in China, and the cGA difference between Chinese patients and patients in the IMWG study. Method: From August 2017 to April 2019, we continuously recruited 336 newly diagnosed elderly (age ≥ 65) MM patients from 21 centers in China. cGA was performed at diagnosis, after treatment cycle 1, after cycle 4, and 1 year after treatment. cGA includes physical conditions (ECOG), activities of daily living (ADL), instrumental ADL (IADL), mini-nutritional assessment (MNA-SF), geriatric depression scale (GDS), mini-mental state examination (MMSE), quality of life (SF-36) and Charlson comorbidity index (CCI). Staging was assessed at baseline (International Staging System (ISS) & Revised ISS) and hematological responses were evaluated along with each cGA timepoint. Results: We pool-analyzed data of 336 newly-diagnosed elderly MM patients. The median age was 70 (range 65-88) and 25.5% of patients were older than 75 years. 336 (100%) patients were able to complete cGA, and median assessment time was 40 minutes (range 20-70). Upon diagnosis, only 34% and 37.5% of patients had full ADL and IADL respectively. 38.5% of patients had moderate to high risk of depression (GDS ≥ 6). 13.2% of patients were malnourished (MNA-SF ≤ 7), while 46.3% of patients were at risk of malnutrition (8 ≤ MNA-SF ≤ 11). 41% of patients had at least one comorbidity (CCI ≥ 1). 45.7% of patients had moderate to intermediate risk of cognitive impairment (MMSE ≤ 26). Grouping by IMWG-GA index, our study identified 59.9% patients in frail group (vs 39% in IMWG study), 15.8% in intermediate (vs 31% in IMWG) and 24.3% in fit (vs 30% in IMWG). 69% of patients received proteasome inhibitor-containing regimens and 20.7% of patients received lenalidomide-containing regimens. Best hematological responses in fit and intermediate groups were better than responses in frail group (≥ PR rate: 88.5% in fit, 94.4% in intermediate vs 77.5% in frail). Median follow up time was 10 months. To date, 215 (64%) patients have finished the cGA after cycle 1; 164 (48.8%) patients have finished the cGA after cycle 4; 91 (27.1%) patients has finished all 4 planned cGA and improvements in cGA were observed in the majority of these patients. Conclusion: Our study showed significant CGA heterogeneity in elderly MM patients. Even in the IMWG-GA "fit" group, nutrition, depression and cognitive impairment remain problems. Frail patients took up a larger proportion in Chinese elderly MM patients compared to IMWG study. Our study strongly justifies the necessity for cGA in elderly patients with MM, more so in the real world MM patients than in the clinical trials. Disclosures No relevant conflicts of interest to declare.

Geriatric Dentistry and Prevention: Research and Public Policy (Reaction Paper)

1991 ◽  
Vol 5 (1) ◽  
pp. 74-77 ◽  
Author(s):  
C. Meyerowitz
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Oral Health ◽  
Dental Health ◽  
Systemic Disease ◽  
The Elderly ◽  
Health Needs ◽  
Oral Disease ◽  
Geriatric Dentistry

The population of older adults is heterogeneous and can be divided into many subgroups: the young-old, the old-old, the healthy, the sick, the frail, the mentally and physically handicapped, the ambulatory, the chair-bound, house-bound or institution-bound, and the economically advantaged and disadvantaged. This diversity is extremely important to the discussion of the oral health needs, preventive health strategies, and research agenda for the elderly. As life expectancy increases, more attention is being paid to disease prevention so that the quality of life in old age can be improved. However, the link among oral health, systemic disease, and quality of life in the elderly needs to be better-defined. There is some evidence in the literature that indicates that coronal and root caries appear to be major health problems for the elderly. This needs to be corroborated in longitudinal studies. Although periodontal disease prevalence and severity are high in some subgroups of the elderly, these appear to be in decline in the general population. Dental health-care workers must be cognizant of the oral conditions associated with systemic disease and the use of medication, a major concern in older adults. Prevention of oral disease in the elderly requires early intervention, education of the dental health team, and innovative uses of well-established preventive agents such as fluoride. An extensive research effort is needed to answer basic and applied questions regarding the oral health needs of the elderly. Federal and private funding will be necessary. The dental profession will have to demonstrate and be persuasive that money spent on research and care for the elderly is money well spent.

scholarly journals Cross Cultural Adaptation and Validation of Nigerian (Igbo) Version of the Older People’s Quality of Life Questionnaire (OPQOL-35): a Validation Study

2021 ◽  
Author(s):  
Ukamaka Gloria Mgbeojedo ◽  
Christopher Olusanjo Akosile ◽  
Chisom Cassandra Ekigbo ◽  
Emmanuel Chiebuka Okoye ◽  
Echezona Nelson Ekechukwu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Internal Consistency ◽  
Developed Countries ◽  
Assessment Tools ◽  
Active Ageing ◽  
Life Questionnaire ◽  
Health And Social Care ◽  
Significant Difference

Abstract Background Quality of life (QoL) has been revealed to determine an older adult’s assessment of successful and active ageing; and to evaluate various range of health and social care interventions. Most QoL assessment tools were developed for use in developed countries. This may not be suitable for developing nations such as Nigeria. There is need for availability of culture- and environment- specific tools for assessment of QoL. This study was therefore designed to cross-culturally adapt the OPQOL-35 into Igbo language, and determine its reliability and validity. Methods The original English OPQOL-35 (E-OPQOL-35) was translated into Igbo language, synthesized, back translated, and subsequently subjected to expert panel review, pre-testing and cognitive debriefing interview, following the American Academy of Orthopaedic Surgeons’ guideline. The final Igbo version (I-OPQOL-35) was tested for internal consistency, concurrent and structural validities in a cross-sectional study of 115 consenting apparently healthy older adults (54.8% females) that were recruited from conveniently selected local government areas in Enugu State, at 0.05 level of significance. Results The OPQOL-35 was cross-culturally adapted to Igbo with all its 35 items retained. The Spearman correlation coefficients between the participants’ domain and total scores on the I-OPQOL-35 and E-OPQOL-35 (rho = 0.92-1.00) were excellent. The Mann Whitney-U test revealed no significant difference between corresponding scores in the E-OPQOL-35 and I-OPQOL-35 (p = 0.65-0.94). The internal consistency coefficient of the I-OPQOL-35 was 0.78. Conclusions The I-OPQOL-35 is therefore a valid and reliable instrument for the assessment of QoL among Igbo older adults in Nigeria.

EFFECTIVENESS OF A COMPREHENSIVE GERIATRIC ASSESSMENT TO IMPROVE THE LIFE QUALITY OF THE ELDERLY AND TO EASE THE CAREGIVERS BURDEN

2021 ◽  
pp. 79-90
Author(s):  
Evgenia A. Gurianova ◽  
Enje E. Rechapova ◽  
Ekaterina S. Sidyakina
Keyword(s):  
Elderly People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Life Quality ◽  
Modern Society ◽  
The Elderly ◽  
Diagnostic Process ◽  
Modern World ◽  
Rehabilitation Programs

In the modern world, the number of elderly people with various diseases is growing, they need an appropriate care. Care implementation requires special knowledge, mental and economic expenditures. Ensuring a decent old age for the elderly is one of the problems of modern society. Comprehensive geriatric assessment is a multidimensional interdisciplinary diagnostic process for assessing the physical, psychological, functional and socio-economic problems of elderly people in order to develop a comprehensive individual plan for their treatment and rehabilitation. Comprehensive geriatric assessment benefits the elderly population, but the effectiveness of comprehensive geriatric assessment to improve the life quality of the elderly remains unclear. The article provides an overview of studies devoted to studying the effectiveness of using comprehensive geriatric assessment. The article discusses the influence of a comprehensive geriatric assessment on determining the life quality of the elderly, the duration of their stay in the hospital, and relieving the caregivers' burden. In addition, the influence of a comprehensive geriatric assessment on the ability to determine life expectancy, to conduct early diagnosis of major geriatric syndromes, the risk of morbidity and mortality in elderly patients is being considered. It is important that on the basis of a comprehensive geriatric assessment, appropriate rehabilitation programs can be drawn up, and technologies for rehabilitation can be determined.

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